Bulimia Causes, Symptoms, & Treatment

While genetic risk plays an important role in the development of bulimia, not all individuals with a family history of this disorder will develop the illness. And, many individuals with no known genetic link to eating disorders develop bulimia.

Genetics

More than 50 percent of the risk of developing an eating disorder is based on your genetics, underscoring a strong familial component to these illnesses. In fact, a woman with a mother or sister who has bulimia is four times more likely to develop bulimia as well.

Personality Traits

Personality traits are believed to be inherited, and a distinct set of traits has been found to be common among those at highest risk for bulimia. Traits like the following tend to characterize those struggling with bulimia:

• High impulsivity
• Unstable moods
• Emotional intensity
• Difficulty seeing the “big picture”
• Cognitive rigidity

Psychological factors, in conjunction with biological and social influences, can play an important role in the development of bulimia nervosa. We have learned that there are certain characteristics and experiences that are common to individuals with bulimia (including perfectionism, low self-esteem and traumatic events), that may place a person at greater risk for the illness. These factors are often considered to be maintaining features that contribute to the perpetuation of the illness and can be directly targeted during treatment.

Low Self-Esteem

When one is experiencing low self-esteem, it can cause feelings of depression which can contribute to the development of eating disorder behaviors. Sources of low self-esteem are varied and can include childhood experiences, temperament styles, and other mental health conditions.

Perfectionism

Perfectionism refers to a personality style where an individual strives for flawlessness, is highly concerned with approval, and may be extremely self-critical regarding performance. Mistakes are often viewed as personal failures – and something to be avoided at all cost. For individuals with bulimia nervosa, high levels of perfectionism can be seen within the illness (e.g., strict rules around eating and food) as well as outside of the illness (e.g., extremely high standards and expectations for themselves in academics, work, etc.).

The sociocultural context (social networks, media influence and cultural norms relating to eating and appearance) during the development of bulimia nervosa requires important consideration. In fact, there are certain aspects of western society values that have been linked to bulimia including the pursuit of the “ideal body” and the overvaluation of appearance as a measure of success and worth.

Messages promoting unrealistic beauty standards that place high value on achieving a certain look (thinness, muscularity) can create pressure to engage in behaviors, like dieting, that place certain persons at greater risk. Other social influences include involvement in specific activities, groups or occupations that emphasize weight and appearance.

Traumatic Events

Research shows that many patients who are struggling with an eating disorder have experienced a traumatic event in their lifetime ^[1]. This is particularly true for patients who have bulimia-spectrum eating disorders ^[2]. Traumatic experiences, with or without a PTSD diagnosis, can lead to disordered eating behaviors as the person attempts to cope with the distressing effects of the traumatic event.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966425/
[2] Brewerton, T. D. (2007). Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. Eating Disorders,15(4), 285-304. https://doi.org/10.1080/10640260701454311

The Thin Beauty Ideal

Western societies equate thinness with female beauty and success, a condition known as the “thin beauty ideal.” ^[3] Studies have demonstrated that cultural pressures to achieve the thin beauty ideal can lead to increased body dissatisfaction and weight concerns, which may then contribute to the development of bulimia nervosa. Western norms for male bodies emphasize extreme muscularity in an equally unrealistic standard. With modern developments like social media, western ideals and values have been disseminated globally. Recent studies have demonstrated increases in eating disorders in non-western cultures as well as minority groups.

[3] Morrissey, R. A., Gondoli, D. M., & Corning, A. F. (2019). Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia? Development and Psychopathology, 32(3), 1031–1043. https://doi.org/10.1017/s0954579419001287

Pressure from Social Media

With social media being a major influence on culture today, there are many negative effects that can lead to disordered eating and bulimia nervosa ^[4]. Being bombarded with media images of extremely thin models, for example, promotes the internalization of anti-fat attitudes and the need to control weight. On social media, there are many images of "perfection", diet talk and before-and-after images that can influence eating disorder development and maintenance.

[4] Rounsefell, K., Gibson, S., McLean, S., Blair, M., Molenaar, A., Brennan, L., Truby, H., & McCaffrey, T. A. (2019). Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition & Dietetics, 77(1), 19–40. https://doi.org/10.1111/1747-0080.12581

• Cardiac complications (irregular heartbeat and heart failure stemming from electrolyte imbalances such as potassium, sodium, and chloride)
• Dehydration
• Edema (stemming from periods of purging cessation)
• Ulcers, pancreatitis
• Esophageal inflammation and/rupture, acid reflux (resulting from vomiting)
• "Bulimia teeth" or tooth decay and staining (caused by stomach acids/frequent vomiting)
• Digestive irregularity (chronic irregular bowel movements and constipation, sometimes stemming from laxative abuse)
• Fatigue and muscle weakness (from over-exercise or electrolyte imbalances)
• Risks associated with diabulimia (manipulating insulin for weight loss in Type 1 Diabetics), including organ damage and peripheral neuropathy

• 5 percent of American women suffer from bulimia nervosa in their lifetime.¹
• Standardized Mortality Ratio (SMR) for Bulimia Nervosa is 1.93 (SMR is a ratio between the observed number of deaths in an study population and the number of deaths would be expected).²
• Nearly half of bulimia patients have a comorbid mood disorder.³
• More than half of bulimia patients have comorbid anxiety disorders.³
• 1 in 10 bulimia patients have a comorbid substance abuse disorder, usually alcohol use.³

By shining a light on bulimia's life-threatening consequences and its pervasiveness, we hope to help increase awareness of this debilitating illness and to encourage those who suffer to get help. With proper treatment, recovery from bulimia is possible.

1. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.
2. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
3. Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Research, 230(2), 294-299.

As one of the most complex mental health illnesses, the research around bulimia nervosa is ongoing. We acknowledge that there are some gaps in the field about this eating disorder condition, however, our team is constantly doing their part to study and analyze bulimia to improve our specialized treatment approach.